Residential Medication Management Reviews and continuous polypharmacy among older Australian women

Abstract

Background: Polypharmacy is an important consideration for the provision of Residential Medication Management Reviews (RMMRs) among older women given their enhanced risk of medication-related problems and admission to residential aged care (RAC). Objectives:To determine the prevalence of the use of RMMRs among older women in RAC, and the association between RMMRs and polypharmacy, medications, and costs.Setting: Older Australian women aged 79 to 84 years in 2005 who had at least one Medicare Benefits Schedule and Pharmaceutical Benefits Scheme record, received a service in aged care, and consented to data linkage.Method: Generalised estimating equations were used to determine the association between polypharmacy and RMMRs, while adjusting for confounding variables. Main outcome measures: Prevalence of the use of RMMRs among older women in RAC, association betweenRMMRs and polypharmacy, medications, and costs.Results: Most participants did not have continuous polypharmacy and did not receive RMMRs from 2005 [451 (67.4%)] until 2017 [666 (66.6%)]. Participants with continuous polypharmacy were 17% more likely to receive a RMMR (risk ratio 1.17; 95% confidence interval: 1.11, 1.25). Participants in their final year of life and residing in outer regional/remote/very remote Australia were less likely to receive RMMRs. Out-of-pocket medication costs increased over time, and alendronate and aspirin were common contributors to polypharmacy among participants who received RMMRs. Conclusion:Polypharmacy was associated with receiving RMMRs and around two-thirds of women who are entitled to a RMMR never received one. There is potential to improve the use of medicines by increasing awareness of the service among eligible individuals, their carers and health care professionals. Impact of findings on practice statements• Our findings suggest that there is a need for medication reviews among older women with polypharmacy.• Even if medication reviews are supported and funded, low uptake may preclude benefits being experienced by patients.• Given the underutilisation of the Residential Medication Management Review service, there is potential to improve the use of medicines by increasing awareness of the service among eligible individuals and their carers through aged care management, nursing staff, and health care professionals.

Innovating medication reviews through a technology-enabled process

“…Finally, coupled with knowledge gained from being trained to conduct medication reviews 6 , 15 , 16 and utilising a guided framework, technology has the potential to improve the efficiency and effectiveness of medication reviews and could, for example, be adapted to focus specifically on older people. 2 , 28 , 29 Technology in the form of a computerised decision support system (CDSS) can ensure that a comprehensive review is conducted in a timely and cost-efficient manner. Cresswell and colleagues (2012) define CDSS as a software application utilising patient data, a database of clinical knowledge, and ‘conditional’ logic, for instance ‘if-then’ and ‘do while’, to produce patient-specific recommendations related to healthcare.…”

“…Medication reviews are effective in improving the quality of medication use among older people, especially older individuals in aged care facilities 1 , 2 and those residing in the community who do not have regular follow-ups with their general practitioners (GPs). Medication reviews are aimed at identifying, resolving and preventing any medication-related problems, and optimising medication use in collaboration with GPs, medical practitioners, other healthcare professionals and patients 3 ; the process is patient-centred.…”